Well-disguised progress

The National Alliance on Mental Illness has given Nevada a D-minus for its treatment of the mentally ill.

That’s lower than the national average, which itself is only a D. Only four states—Arkansas, Indiana, Louisiana and Nevada—received D-minus grades. Eight states received F grades, and two weren’t ranked because they failed to supply information.

The Alliance gave a breakdown of what went into Nevada’s D-minus. The state received D grades for mental health services and for support provided during recovery. It received F grades in infrastructure and access to information.

The group said Nevada’s $68.78 per capita mental health spending put it 36th among the states. It has more suicides than all but three states.

Nevada’s D-minus may seem like a dismal ranking, but nearly all parties, including the Alliance itself, call it a sign of progress. “At least it wasn’t an F,” said Assemblymember Sheila Leslie of Washoe County. “That’s an improvement right there!”

The Alliance praised recent developments in the field in Nevada—"State-funded mental health courts, transparency, demonstrated by self-reported data posted on its Web site, efforts to reduce restraints and seclusion in hospitals, funding increases for emergency room and jail diversion.”

But it says the state has “overflowing emergency rooms, particularly in Las Vegas,” and needs “implementation of evidence-based practices,” more aggressive programs for the seriously ill, and “supportive housing options, especially in rural areas.”

“On a positive note, the Nevada Division of Mental Health and Developmental Services is not trying to hide these problems,” the report says. “In fact, the division in recent years has frankly acknowledged high levels of unmet need among people with serious mental illnesses in the state, and has engaged in a number of efforts to try to bridge these gaps.”

While some local spokespeople found minor problems with the report, they agreed with its principal findings. Although Nevada is no example for the nation, they said, it is making some progress.

“The F in infrastructure is a real issue,” said University of Nevada, Reno professor of psychiatry Ole J. Thienhaus in a written statement. “Psychiatric patients, whether it’s an otherwise functioning—spouse, parent, worker—person in crisis, a homeless, maladapted schizophrenic person, or a chronic patient who is decompensating suddenly because he ran out of meds – they’re all immediately the responsibility of the state MH system. In other states, patients in crisis are admitted to beds in a general hospital, stabilized over a few days, and then either a private psychiatrist or case management takes over.

“In Nevada, the hope is that “more beds” (in segregated psychiatric hospitals, of course) will be the solution. It’s hard not to suspect that we mainly want these patients to be cleared out of the way: Inpatient psychiatry really offers no more than a safe holding environment. What we need is investment in rehabilitation services for the long-term dysfunctional.”

Leslie said last Friday, “I know from my work in Mental Health Court that we are making significant improvements in serving severely mentally ill people in the criminal justice system. Just this morning we were able to add a psychiatric nurse to the team. She will assist us in making sure our clients are able to quickly see a psychiatrist when [there are] needs for more effective medication management and also address other serious health problems that are common in this population.”

The Alliance, Leslie and Thienhaus all pointed to recent developments in suicide prevention as a positive indice, but Thienhaus warned against smugness.

“A new suicide intervention program and funding for the treatment of pathological gambling, both passed by the last legislative session, are going in the right direction. But let’s not kid ourselves—we’re taking little baby steps, while the problem grows as fast as the population of Nevada.”

Nevada has long had a reputation for indifference to mental health needs. In 1955, Collier’s magazine, then a leading publication, said the state mental hospital was understaffed, mental health clinics non-existent, and the state had one of the highest suicide rates. The same conditions prevailed in 2001 when the New York Times ran a front page story on Nevada’s poor quality of life.

There have been periods when progress was made, but the gains didn’t often hold. Gov. Robert Miller won better programs shortly after taking office, but when the recession of 1991 hit and caused state revenue to plunge, mental health programs were cut severely.

Gov. Guinn has provided strong support for most mental health programs, including the first-ever state funding for gambling addiction treatment.